Not getting what you pay for

Back in the old days when I was famous, I used to go around and talk about health care reform before various audiences, including out on Cape Cod every summer where the vacationing crowd tended to include a lot of doctors and their fledgling doctor offspring. (Yup, it runs in families.) After I got done explaining why we need universal, comprehensive, single payer national health care, I'd always get a raised hand and a whiny objection about how "Here in the U.S., we have the highest quality health care in the world."

I had plenty of snappy answers back then (such as, how is it high quality if 15% of the people can't get any primary care, and how come we don't live as long and aren't as healthy as the people in those low quality countries?) but now I've got another one. Folks over at my beloved Commonwealth Fund (Blogger ethics alert: they give me money, but depressingly little), surveyed relatively sick people in six affluent countries, five of them English speaking because I guess they didn't have time to learn French or Norwegian.

Anyhow, here in the U S of A we do okay on some things like communicating risk and discharge planning, at least based on patient self-reports (although these are not good sources of info on risk communication, since if they failed to communicate adequately, you wouldn't know it, right?). However, when it comes to screwing up, We're Number One!

Fifteen percent of U.S. respondents said they were the ungrateful beneficiaries of a medical mistake, tied with Canada for the top spot. We won "Given the wrong medication or the wrong dose" hands down, at 13%, with Australia, Canada and Germany tied for second at 10%, so we are alone in first place for having people experience some kind of error. For those who experienced and error, we also won runner up for the Cover Your Ass award, with 75% not being told about the error by their doctors. (Germany actually won that one at 83%.)

We win the prize for getting the wrong results from a lab test in a runaway (10% vs. 7% for runner up Canada), and we nudge out Canada 16% to 15% for delays in getting results from an abnormal lab test.

Now, I don't know how reliable these self-reports are in telling us the number of errors that actually happen. Much of the time, people probably don't even know that they were the victim of a medical error, and on the other hand people may decide that an error happened just because they are unhappy with the results. Sometimes doctors have to go with the percentages and being wrong isn't exactly the same thing as making a mistake. Still, folks who are served by the highest cost, fanciest, highest tech, most razzle dazzle health care system in the world are also perceiving it as not the highest quality, but the lowest, among these particular wealthy countries. That has to mean something.